1.
A 44-year-old woman with no known past medical history except for a "heart murmur" noticed in her early teenage years, has a sudden onset of "crushing substernal chest pain, radiating to the back". She then becomes severely hypotensive and unresponsive. What is the most likely diagnosis?
A. 
B. 
C. 
Calcific degeneration of mitral valve
D. 
Congenital bicuspid aortic valve
E. 
Ventricular septal defect
2.
A 32-year-old male who has been diagnosed as having aortic stenosis secondary to a bicuspid aortic valve develops classical angina pectoris after running 1.5 miles on uphill terrain. He consults a physician who confirms the diagnosis and determines that on examination his BP is 140/60 mmHg, and the patient has a harsh systolic ejection murmur radiating to the neck accompanied by a diastolic murmur compatible with associated aortic regurgitation.
What is the mechanism for his chest pain most likely to be?
A. 
B. 
Undiagnosed coronary artery disease
C. 
Abnormal diastolic blood pressure
D. 
Increased ventricular compliance
E. 
3.
A 30 year old woman presents for a routine checkup. She has no complaints and denies previous medical problems. On heart examination, the patient has a loud S1. She has a low-pitched mid-to-late diastolic murmur that is heard best at the apex. Immediately preceding the murmur is a loud extra sound. Which of the following is the most likely diagnosis?
A. 
B. 
C. 
Ventricular septal defect
D. 
E. 
4.
You have been seeing a 2-year-old female child at your clinic who has Tetralogy of Fallot. The parents are concerned because she has often been seen taking a "squatting" position on the floor multiple times per day. Since you know this is normal behavior, how do you explain it to the parents?
A. 
It prevents blood from flowing out of the heart causing it to go into the lungs
B. 
It changes the flow of electrical current in the heart
C. 
It prevents blood from flowing into the liver where it may pool
D. 
It decreases the flow of blood returning to the heart
E. 
It causes more blood to be shunted to the brain
5.
Which of the following are the mechanisms of left atrial failure in a patient with a mitral stenosis?
A. 
Reduced preload, volume overload, and pressure overload
B. 
Volume overload, pressure overload, and impaired contractility
C. 
Increased preload, increased afterload, and impaired contractility
D. 
Increased preload, reduced afterload, and impaired contractility
6.
You are presented with the following findings
The most likely complication found in this patient is/are:
A. 
B. 
C. 
D. 
E. 
7.
This patient presents to you office for a physical exam. Blood pressure is 145/88. Your exam findings include a bispherians carotid pulse as well as a high frequency diastolic decrescendo murmur (aortic area) with an apical diastolic rumble. The most likely cause would be:
A. 
B. 
C. 
D. 
8.
A 74-year-old Caucasian female presents to her family physician for evaluation of recurrent episodes of chest pain, shortness of breath with exertion, and lightheadedness. Two weeks earlier she experienced an episode of syncope while walking up the stairs of her house. Doppler ultrasonography reveals a heavily calcified aortic valve. The image below represents gross appearance of the patient’s heart. Which of the following is the most likely diagnosis?
A. 
Aortic stenosis of rheumatic heart disease etiology
B. 
Aortic stenosis of luetic etiology
C. 
Aortic stenosis after subacute bacterial endocarditis
D. 
Calcific stenosis of congenitally bicuspid valve
E. 
Senile calcific aortic stenosis
9.
The lesion shown in PICTURE below was observed at autopsy of a 35-year-old African American male, intravenous drug user who died 3 days after an acute febrile illness. What laboratory test finding is most likely to be found in the patient’s medical record?
A. 
Elevated anti-streptolysin–O titer
B. 
C. 
D. 
Positive culture for Staphylococcus aureus
10.
A 34-year-old Caucasian male is brought to the emergency room with shortness of breath and heart palpitations. His past medical history is significant for a ventricular septal defect. Physical examination reveals cyanosis, pitting edema of the lower legs, distended jugular veins, and hepatosplenomegaly. Heart examination reveals harsh holosystolic murmur and thrill at the left sternal border. Which of the following complications has most likely developed in this patient?
A. 
B. 
C. 
D. 
11.
A 56-year-old Caucasian man presents with recurrent precordial pain and frequent episodes of lightheadedness, muscle weakness and feeling faint. The patient reports that the symptoms first occurred three years ago and then gradually progressed. Physical examination reveals a heart rate of 88 bpm, BP of 130/69 mm Hg, a systolic "thrill" at the second right intercostal space, S4, and diminished S2 and crescendo-decrescendo systolic murmur over the aorta. What type of carotid pulse is most likely to be found in this patient?
A. 
B. 
C. 
D. 
12.
Squatting has which of the following cardiovascular effects?
A. 
It has the opposite effect of passive leg raising
B. 
It decreases the murmur of mitral regurgitation
C. 
It decreases the murmur of ventricular septal defect
D. 
It increases the murmur of aortic insufficiency
13.
A 30-year-old woman presents for a routine checkup. She has no complaints and denies previous medical problems. On heart examination, the patient has a loud S1. She has a low-pitched mid-to-late diastolic murmur that is heard best at the apex. Immediately preceding the murmur is a loud extra sound. Which of the following is the most likely diagnosis?
A. 
B. 
C. 
Ventricular septal defect
D. 
14.
In rheumatic Heart Disease which of the following statements would be correct?
A. 
There is invariably a preceding Coxsackie viral infection
B. 
Mitral stenosis appears early in the clinical progression of the disease
C. 
The Right heart is more commonly affected than the left
D. 
There has been a recent resurgence of this disease since HIV has become prevalent
E. 
Aortic regurgitation & Mitral regurgitation are well recognized sequelae